This study assesses the views and experiences of psychiatrists of the Mental Health (Care and Treatment) (Scotland) Act 2003. A postal questionnaire was sent to 340 consultant psychiatrists and specialist registrars throughout Scotland.

A response rate of 76% was achieved (n=257); 31 respondents (12%) felt patient care had improved with the newAct; 167 (65%) felt that informal patients' care had suffered; 135 (52%) did not consider that tribunals were better than the previous court system; 151 (59%) felt that the out-of-hours workload had increased.

An early indication of psychiatrists' views and experiences of the new Mental Health (Care and Treatment) (Scotland) Act 2003 is given.

Homelessness is associated with raised psychiatric morbidity. Case records for 597 consecutive attendees at a winter shelter medical service were retrospectively reviewed to assess routine recording of psychiatric morbidity and to examine associations between current psychiatric symptoms and health service use.

Previous psychiatric morbidity was recorded in 36.0% of attendees, including 20.4% with comorbid substance misuse. Current psychiatric morbidity was recorded in 31.3% of attendees, and was associated with reduced total medication prescription, increased referral to other services and increased re-presentation to the shelter medical service.

Psychiatric morbidity was frequently recorded in this population. Current psychiatric symptoms were associated with increased health service use. Improved training of shelter staff should be instituted to increase engagement with mainstream mental health services.

We evaluated the impact of implementing the individual placement and support (IPS) approach within eight community mental health teams (CMHTs) in two London boroughs. Demographic, clinical and vocational data were collected enabling a comparison of the number of people supported in work/education and individual client outcomes at 6 and 12 months.

Following the integration of employment specialists there were significant increases in the number and proportion of clients engaged in mainstream work or educational activity at 6 months and 12 months. The employment specialists supported 38% in open employment at 6 months and 39% at 12 months.

The results support the use of IPS in clinical practice in CMHTs.

To investigate how much reliance on suicide verdicts underestimates probable suicides. All unnatural deaths of those 8–18 years of age in West Yorkshire during a 6-year period were identified from the death register. Deaths which had verdicts other than killed him- or herself and were not obviously accidental were reviewed by a panel of three consultant child and adolescent psychiatrists to determine whether they were probable suicides.

Of 40 deaths reviewed by the panel, 13 were identified as probable suicides, of which 6 had an open verdict, 6 were death by self-hanging classified as misadventure and 1 was an overdose with a verdict of accidental death. These 13 deaths and the 7 with a coroner's verdict of suicide gave a total of 20 probable suicides.

Suicide statistics and targets need to take into account the fact that by current methods a significant proportion of suicides by adolescents will not be included in official figures. This underestimation would have been 65% if only suicides were identified and 35% when open verdicts were combined with suicides. Underestimating the youth suicide rate has consequences for the priority and resources allocated to preventing these deaths, and suicide deaths that are not recognised as such will not be included in relevant research and audit.

To develop a service development plan supporting recovery-based practice through collaborative service user-led methodology, and contribute to the National Institute for Mental Health in England (NIMHE) pilot evaluation of recovery sensitive measures. Staff, residents and service user group representatives collaborated in implementing the Developing Recovery Enhancing Environments Measure (DREEM) in a residential rehabilitation service.

Staff and residents demonstrated a shared vision of recovery. Many areas were being addressed to a high level but others showed areas of deficiency, and illustrated discrepant views between staff and residents, which provided a focus for the development of a clinical service action plan.

As an experimental measure DREEM provides a user-led structure, which enables services to measure their commitment to, and effectiveness in, providing recovery-based care. It focuses service development and enhances collaborative work with service users, thus mirroring the principles of recovery it measures. It merits further evaluation and consolidation.

Although financial incentives to improve treatment adherence have been found effective in various medical specialties, there are few systematic data on their use, ethical background and effectiveness in psychiatry. We explored the practice of and possible ethical problems associated with direct financial incentives to improve adherence in assertive outreach teams in England. We also report clinical observations of a money for medication scheme with five assertive outreach patients in East London.

None of the assertive outreach teams that responded to the survey (response rate 47%) uses financial incentives. Attitudes of team managers towards the practice were mostly negative, often regarding it as unethical. Specific concerns were related to possible coercion and a negative impact on the therapeutic relationship. Out of five patients studied, four accepted the offer of money and had improved adherence; three remained without hospital admission since entering the scheme.

Money for medication might be a non-coercive and effective option to achieve medication adherence in otherwise non-adherent assertive outreach patients. However, ethical issues need further exploration and controlled trials are required to establish the effectiveness.